The article presents an analysis of the results of dynamic observation of a group of servicemen with dyspepsia without erosive and ulcerative lesions (n = 143) during the period of compulsory military service. As a result of dynamic observation for 8 to 18 months, the frequency of relapses of dyspepsia (excluding the results of eradication of Helicobacter pylori – H. pylori infection) was 27.3 % (95 % CI 20.6–35.1), the duration of remission after the first manifestation symptoms – 92 days (58–154) Me (LQ-UQ), duration of relapse – 12 days (11–17) Me (LQ-UQ). In H. pylori-negative and H. pylori-positive servicemen who did not receive eradication therapy, the frequency of relapses of dyspepsia did not differ (26.8 % versus 23.7 %; χ2 = 0.17, p = 0.68). During the observation period, diseases were detected or developed: in 1.4 % (95 % CI 0.4–4.9) – erosion of the mucous membrane (МM) of the duodenal bulb, in 1.4 % – esophagitis st. A and B, 2.8 % (95 % CI 1.1–6.9) are not associated with the digestive system. When examining for recurrence of dyspepsia symptoms, new morphological cases were diagnosed – 1 (0.7 %) atrophy, 2 (1.4 %) – intestinal metaplasia, 1 (0.7 %) – low-grade dysplasia (all cases with localization in the antrum section of the stomach ММ). The results of the study served as the basis for the development of an algorithm for diagnosing diseases of the upper gastrointestinal tract (GIT) in case of dyspepsia in conscripts at the stages of medical care in the Armed Forces of the Republic of Belarus.

This publication is a continuation of the article «Syncope: to help the practitioner» (Communication 1). It outlines actual approaches to the diagnosis and interpretation of data from clinical and instrumental research methods in patients with various types of syncope in accordance with the recommendations of the American College of Cardiology (2017) and the European Society of Cardiology (2018).

The article presents the main provisions of recent recommendations for the use of diagnostic methods in patients with various types of syncope.

The emphasis is placed on the possibilities of diagnostics after the initial examination to determine the subsequent treatment tactics, prevent possible complications, and resolve expert questions.

Broad information about pneumonia and related observations of atypical pneumonia over the past two decades in Minsk.

Risk factors for gastroduodenal erosions (GDE) in conscripts with dyspepsia were studied. An increased chance of detecting GDE during smoking was established – odds ratio OR = 3.3 (95 % CI 1.5–7.1); NNH = 5 (95 % CI 3–9); the minimum value of the smoking index (SI) is 1.05 pack / year. The cutoff point SI = 1.35 pack / year has the optimal value for a preliminary assessment of the presence of GDE in conscripts with dyspepsia with a sensitivity of 80.8 % and a specificity of 91.5 %. An increased chance of detecting GDE in persons who started smoking before the age of 18 was established: OR = 4.8 (95 % CI 2.5–9.3); NNH = 3 (95 % CI 1–5). The proportions of patients with moderate (39.3 %) and severe (14.3 %) degree of polynuclear infiltration with localized erosions in the antrum were significantly higher than in patients with chronic antral gastritis without GDE (χ2 = 4.26, p = 0.04 and χ2 = 5.11, p = 0.02), and cases of intestinal metaplasia (14.3 %) were detected only with erosions.

The concentration of reagins in nasal secretions in perennial allergic rhinitis was investigated, which was 118.87 (90.50; 147.24) IU / ml, which is significantly higher (p < 0.001) than in healthy individuals. In parallel, the concentration of reagins in the blood serum was investigated, which was 132.34 (124.47; 190.21) IU / ml, which is also significantly higher (p <0.001) than in healthy individuals. During the study, no correlations were found between the concentration of reagins in both nasal secretions and serum and the duration of perennial allergic rhinitis, as well as the severity of its symptoms. At the same time, the probability of detecting a diagnostically significant concentration of reagins (more than 100 IU / ml) in patients with perennial allergic rhinitis in the blood serum (OR = 90.0) significantly exceeded the same indicator for nasal secretions (OR = 23.3).

Objective: to evaluate the efficiency and toxicity to metronomic chemotherapy and to investigate factors of sensitivity to this kind of treatment.

Material and methods. The results of treatment of patients with metastatic colorectal cancer (mCRC) who were treated at Minsk City Clinical Oncologic Dispensary in 2016–2019 were analyzed (n = 140). Patients included in the main arm after the completion of standard therapy were prescribed metronomic maintenance chemotherapy, while patients in the control arm – dynamic observation only. Metronomic regimen consisted of oral capecitabine 500 mg 3 times a day and oral cyclophosphane 50 mg daily.

Results. The most common effect of metronomic maintenance chemotherapy is tumor stabilization (42.9 %). The use of metronomic maintenance chemotherapy in patients with mCRC can increase the median progression-free survival (PFS) from 7.4 to 9.1 months, and the median overall survival (OS) from 15.0 to 23.3 months (p < 0.001). The proposed treatment regimen is well tolerated by most patients; the toxicity of metronomic chemotherapy does not limit its duration. Metronomic maintenance chemotherapy is more effective in patients with low levels of CEA and CA 19–9 tumor markers. The median PFS in patients with CEA level below 2 upper limits of normal (ULN) was 10.6 months and 7.2 months at a marker level above this value (p <0.001). For groups of patients with CA 19–9 levels above and below 2 ULN, median PFS was 7.0 months and 10.3 months respectively (p <0.001). Patients with reduced levels of expression of the TS, DPD, Flt-1 genes have higher values of PFS (p = 0.0006, 0.0235 and 0.015, respectively) and OS (p = 0.0004, 0.041 and 0.0213, respectively). At the TS expression level below 6.3 rel. units risk of progression within 9 months decreases by 71 % (18 %, 148 %), with the TP level above 6.1 rel. units. – by 37 % (6 %, 75 %).

Conclusion. The use of metronomic maintenance chemotherapy increases the effectiveness of treatment of patients with mCRC without significantly increasing toxicity. The optimal criteria for sensitivity to this method of treatment are the levels of tumor markers CEA and CA 19–9 below 2 ULN, the expression level of the TS gene below 6.3 relative units.

Diffusion lung capacity shows the state of the gas exchange lung zone. Disorders resulting in a decrease in the diffusion surface area or an increase in its thickness lead to a decrease in oxygen diffusion through the alveolarcapillary membrane. The objective of the study was to assess the peculiarities of diffusion lung capacity in patients with spondylarthritеs depending on the clinical and laboratory data, as well as the anamnestic information. The study involved 58 patients with spondylarthritеs: 39 men and 19 women. The interview considered their past medical history and respiratory complaints. The x-ray stage of spondylarthritеs was determined, as well as the disease activity index BASDAI. Spine mobility was evaluated using tragus-to-wall distance, chest expansion and modified Schober test. Blood tests were taken to determine the Chlamydophila pneumoniae infection markers. Diffusion lung capacity was tested. A decrease in diffusion lung capacity was observed significantly more frequently in the patients with spondylarthritеs and thyroid disorders, this group included only women. The patients with spondylarthritеs and thyroid disorders showed a significant increase in respiratory complaints, namely dyspnea. These peculiarities may be present due to common regulatory mechanisms of lung and thyroid pathology. The patients with spondylarthritеs and the Chlamydophila pneumoniae infection acute phase markers in blood showed normal parameters of diffusion lung capacity.

To provide hygienic assessment of actual nutrition the study tested 203 menu layouts of students of 2–3 years of the Belarusian State Medical University. We revealed insufficient intake of basic nutrients among male and female students. About 31 % of the surveyed male students and 25 % of female students have deviations from the physiological value of the body mass index.

The aim of this study is to analyze the medical consequences 30 years after the Chernobyl accident. The object of the study was the Luninetsky district of the Brest region, contaminated with radionuclides, including I-131. Analysis of the radiation exposure due to radioiodine showed that about half of the inhabitants of this area received absorbed doses in the range of up to 0.1 Gy. At the same time, the highest doses were formed in children who at the time of the accident were under 10 years old. The greater radiation impact was exerted on the female part of the population. The relationship between the age at the time of the accident and the absorbed dose on the thyroid gland is characterized by a complex nature, characterized by a wide range of dose distribution in childhood than in adulthood. The increase in the incidence of thyroid cancer in the Stolin district began in the early 90s, in men a little later and its dynamics has no gender characteristics. Analysis of the annual incidence of thyroid cancer revealed three peaks in 1996, 2005 and 2016. The analysis of morphological forms of cancer in patients in the sample of the oncological registry showed the dominance of three main forms of thyroid cancer: follicular of papillary cancer (8340/3), papillary adenocarcinoma (8260/3), and medullary carcinoma (8345/3. The strongest correlation was found between the absorbed dose and stage T1 thyroid cancer. These data are also confirmed by the ERR value equal to 3.7 (95 % CI: 1.24, 10.99), which can unequivocally testify in favor of the radiation nature of thyroid cancer in residents of the Luninetsky district of the Brest region.

Purpose: to assess the effect of autologous mesenchymal stem cell transplantation (AuMSCT) on optical coherence tomography indicators in patients with relapsing-remitting multiple sclerosis (RRMS).

Material and methods. The main group included 50 eyes of 25 patients with RRMS who underwent AuMSCT. The comparison group consisted of 68 eyes of 34 patients with RRMS who did not receive drugs that modify the course of the disease. For OCT, the diagnostic system Stratus OCT 3000 (Carl Zeiss Meditec) was used. To determine the thickness of the retinal nerve fiber layer (RNFL), the protocol for examining the optic nerve head Fast RNFL Thickness was used, to determine the integrity of the retinal ganglion cells (RGC) in the central zone, the protocol for examining the macular zone Fast Macula, an indicator of total macular volume (TMV) was used.

Results. After 6 and 12 months, the number of eyes in which the average thickness of RNFL increased compared to that before AuMSCT in the main group was significantly higher when compared with the comparison group. 2 years after AuMSCT, this difference leveled off. After 3 years, the RNFL thickness indicator again significantly differed in the studied groups. This suggests a neuroprotective effect of AuMSCT on RGC axons in patients with MS. There were no statistically significant differences between the groups in the number of eyes with a change in TMV after 6 months, 1, 2 and 3 years.

Conclusion: the index of the thickness of the peripapillary RNFL can be recommended as a biological marker of the therapeutic effect of AuMSCT at the level of an individual patient.

The method of laser photocoagulation of the peripheral branches of the Vidian nerve is carried out endoscopically using an endonasal approach. However, endoscopic landmarks for localizing the peripheral branches of the vidian nerve are not well described. This study was aimed at creating and analyzing three-dimensional models of the nasal cavity to study the anatomy of the peripheral branches of the Vidian nerve and to determine the endoscopic endonasal approach during laser photocoagulation of the peripheral branches of the Vidian nerve using three-dimensional reconstruction of scanned images of computed tomography.

The aim of this study was to create and analyze three-dimensional models of the nasal cavity to determine endoscopic endonasal access during laser photocoagulation of the distal branches of the vidian nerve.

Materials and methods. X-ray computed tomograms of the nose and paranasal sinuses of 12 patients were prospectively evaluated. The morphology of the wedge-palatine foramen, posterior parts of the middle nasal passage, the place of attachment of the inferior turbinates to the lateral wall of the nasal cavity, the region of the ethmoidal crest (crista ethmoidalis) of the perpendicular plate of the palatine bone, as well as the spatial relationships between them were measured on a three-dimensional model and the endoscopic endonasal access with laser photocoagulation of the peripheral branches of the vidian nerve.

Results. The average distance between the ethmoidal crest (crista ethmoidalis) and the posterior end of the inferior turbinate was 0.5 ± 0.2 cm – a conditional horizontal line. The average distance from the wedge-palatine foramen to the posterior end of the inferior turbinate was 0.7 ± 0.1 cm – a conditional diagonal line. The point of intersection of these lines corresponded to the exit point of the distal branches of the Vidian nerve. The diameter of the wedgepalatine opening is 0.3 ± 0.1 cm.

Conclusions. Endoscopic endonasal access with laser photocoagulation of the peripheral branches of the vidian nerve will be performed with greater accuracy and safety by understanding the spatial relationship between the ethmoid crest of the perpendicular plate of the palatine bone and the posterior end of the inferior turbinate, as well as the wedge-palatine foramen and the posterior end of the inferior turbinate.

The article reflects the modern theory of the pathogenesis of preeclampsia, the influence of calcium deficiency on the development of endothelial dysfunction that develops in preeclampsia. We present our own data on the hypothetical pathogenesis of preeclampsia in pregnant women with calcium deficiency, which reflects perfusion disorders in target organs. Of these changes in the body of pregnant women who are at risk of developing preeclampsia or if it is present, it should be recommended to change the diet, as well as the use of calcium preparations for preventive purposes.

In the context of the COVID-19 pandemic, it becomes necessary to seriously consider all possible options for working with addicted patients. Such large-scale changes in politics, economics and organization of health care are likely to change the landscape of psychoactive substance (PAS) use and many methods of helping addicts. How the use of psychoactive substances will affect the course of the disease in infected drug addicted patients? What will quarantine change in the structure of surfactant consumption? In this review, an attempt has been made to consider the research data in this matter of specialists from different regions of the world.

Starting the story about diseases of the small intestine, let us recall the saying «Repetition is the mother of learning» and draw the attention of experienced doctors and young specialists to anatomy, physiology, morphology and other sections that comprehensively characterize the small intestine as such. The review describes the details of the initial section of the small intestine – the duodenum, the anatomy of a special zone – the zone of the Vater nipple. Further, the structural features of the intestinal wall, including folds, villi, microvilli, glycocalyx; a total significant increase in the surface of the small intestine, where the breakdown of food occurs after preparation in the oral cavity and stomach. This is a very important process in the human body, which takes place in the small intestine, thanks to the intracavitary and parietal (membrane) digestion, as a result of which proteins, fats and carbohydrates are broken down into monomolecules for further absorption and maintenance of the human body in a healthy state.
The intestine is called the largest endocrine and immune organ, the article focuses on enterochromaffin cells, stem cells that provide physiological regeneration of enterocytes. The article also describes lymphoid tissue cells, which allow the coexistence of a person and the microcosm living in their intestine.

Taking into account the growing interest of the world scientific community in the problem of pathological gambling addiction, the novelty of the problems of online gambling that have appeared in recent years, the issues of comorbidity and other mental and addictive pathology, we consider it important to pay attention to this kind of clinical case in this article. It should be noted that in the ICD-11 planned for release, online gambling is supposed to be included as a separate category, different from traditional gambling and Internet gaming addiction, which makes us think about the need for an in – depth study of the clinic, differential diagnosis and therapy of this disorder.

The article provides a review of recent studies on the effect of exercise on erectile function in patients with risk factors: physical inactivity, obesity, hypertension, metabolic syndrome, vascular atherosclerosis. Briefly describes recommendations on the nature, duration and intensity of exercise that can be used to treat erectile dysfunction.

Prevention of diseases has always been the basis of the quality of medical care, since it is obvious that it is always easier and more cost-effective to prevent a disease than to treat it. Of particular importance are preventive measures aimed at preventing the development of cancer, identifying possible risks, precancerous processes and the earliest possible diagnosis of malignant neoplasms. Therefore, it is very important to develop screening of the most frequent cancer localities as part of preventive medicine in General in our country.